Background. Medicare beneficiaries are entitled to a maximum of 100 days of skilled nursing facility (SNF) care in a benefit period when they meet specific coverage criteria. However, Medicare Part A only covers the full cost of a beneficiary’s skilled care during the first 20 days of a nursing home stay. Starting on … Read more

Reports that 20% or more of unplanned hospital readmissions are avoidable has led to considerable interest in policymakers in reducing readmissions.[1]  Actively reducing hospital readmissions is seen as a route to lower Medicare spending and improved patient care. The Affordable Care Act (ACA) established a penalty program for preventable readmissions.  Under the Hospital Readmissions Reduction … Read more

Skilled nursing facilities (SNFs) often tell Medicare beneficiaries and their families that they intend to “discharge” a Medicare beneficiary because Medicare will not pay for the beneficiary’s stay under either Part A (traditional Medicare) or Part C (Medicare Advantage).  Such a statement unfortunately misleads many beneficiaries into incorrectly believing, not only that Medicare has decided … Read more

Medicare beneficiaries often need care in a Medicare- participating skilled nursing facility (SNF) after an inpatient hospitalization.  For these patients, hospitals are responsible for identifying skilled nursing facilities within the geographic region that can meet the patient’s medical needs.  Until such a placement is found, the beneficiary will not be responsible for her hospital stay.  … Read more

On November 3, 2015, the Centers for Medicare & Medicaid Services (CMS), published in the Federal Register (80 Fed. Reg. 68126), proposed revisions to requirements for discharge planning for hospitals, CAHs, and HHAs. The proposed rule is also available at http://www.gpo.gov/fdsys/pkg/FR-2015-11-03/pdf/2015-27840.pdf.  Comments on the proposed rule must be submitted to CMS by 5 p.m. on … Read more

On May 17, 2013, the Centers for Medicare & Medicaid Services (CMS) released an update of Appendix A of the State Operations Manual (SOM) revising its interpretive guidelines for hospital Discharge Planning.[1]  Medicare discharge planning is a Condition of Participation for hospitals, including psychiatric hospitals.[2] Medicare-participating hospitals must make their discharge planning process available to … Read more

Introduction Discharge planning[1] is an important tool for reviewing and making arrangements for on-going healthcare needs across healthcare settings, including hospitals, skilled nursing facilities, home health, or hospice.  When focusing on discharge planning, beneficiaries and their advocates should carefully read all documents that purport to explain rights to services, including discharge evaluations and discharge planning … Read more

Discharge planning[1] is an important tool for reviewing and making arrangements for on-going healthcare needs across healthcare settings, including hospitals, skilled nursing facilities, home health, or hospice. When focusing on discharge planning, beneficiaries and their advocates should carefully read all documents that purport to explain rights to services, including discharge evaluations and discharge planning documents. … Read more